Provider Demographics
NPI:1861798324
Name:CREW, ELIZABETH DAWN (DPH)
Entity type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:DAWN
Last Name:CREW
Suffix:
Gender:F
Credentials:DPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:631 E MISSOURI ST
Mailing Address - Street 2:
Mailing Address - City:WALTERS
Mailing Address - State:OK
Mailing Address - Zip Code:73572-1605
Mailing Address - Country:US
Mailing Address - Phone:580-875-6161
Mailing Address - Fax:580-875-6363
Practice Address - Street 1:631 E MISSOURI ST
Practice Address - Street 2:
Practice Address - City:WALTERS
Practice Address - State:OK
Practice Address - Zip Code:73572-1605
Practice Address - Country:US
Practice Address - Phone:580-875-6161
Practice Address - Fax:580-875-6363
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-01
Last Update Date:2011-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK12274183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist